O33 Per-protocol repeat kidney biopsy portends relapse and long-term outcome in incident cases of proliferative lupus nephritis. (23rd March 2020)

• Record Type: Journal Article
• Authors: Parodis, Ioannis; Adamichou, Christina; Aydin, Selda; Gomez, Alvaro; Demoulin, Nathalie; Weinmann-Menke, Julia; Houssiau, Frédéric A; Tamirou, Farah
• Is Part Of: Lupus science & medicine. Volume 7(2020)Supplement 1
• Page Start: A26
• Page End: A26
• Publication Date: 2020-03-23
• Subjects: Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1136/lupus-2020-eurolupus.44
• Languages: English
• ISSNs: 2398-8851

Abstract

Abstract : Background: In patients with Lupus Nephritis (LN), clinical response to treatment and renal histopathology have been shown to be discordant. We investigated whether per-protocol repeat renal biopsies are predictive of LN relapses and long-term impairment of renal function. Methods: Forty-two patients with an incident biopsy-proven active proliferative (class III/IV ± V) LN from the LN database of the Université catholique de Louvain were included in the present retrospective study. Per-protocol repeat kidney biopsies were performed in all patients after a median time of 24.3 (IQR: 21.3–26.2) months. The NIH activity index (AI) and chronicity index (CI) scores were assessed in both baseline and repeat biopsies. Results: Despite a moderate correlation between urinary protein/creatinine (U-P/C) ratios and AI scores at repeat biopsy (r=0.48; P=0.001), ten patients (23.8%) with U-P/C ratios <1.0 g/g still had a high degree of histological activity (AI score >3; figure 1 ). High AI scores in repeat biopsies were associated with an increased probability and/or shorter time to renal relapse (N=11) following the repeat biopsy (HR: 1.2; 95% CI: 1.1–1.3; P=0.007), independently of proteinuria levels. High NIH CI scores in repeat biopsies were associated with a sustained increase in serum creatinine levels corresponding to ≥120% of the baseline value (HR: 1.8; 95% CI: 1.1–2.9; P=0.016) through a median follow-up time of 131.5 (IQR: 73.8–178.2) months. Baseline AI/CI scores were not predictive of these outcomes. Conclusions: Our results highlight the usefulness of per-protocol repeat biopsies as an integral part of the treatment evaluation, also in patients who have shown adequate clinical response.